Vitamin D Deficiency Prevalence in Industrialized Countries

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Abstract

Vitamin D deficiency in the body, especially subclinical vitamin D deficiency, is common in both developed and developing nations. However, the deficiency is prevalent in developed countries for various reasons. This deficiency affects approximately 5% of the United States population. Despite the U.S not being the country with the most deficiency cases, it still records high cases of deficiencies annually. It is quite saddening that these cases continue to rise by day despite all the efforts employed by the government to put vitamin D deficiency under control with the hope of eliminating it from society. Last year alone, the country recorded 30% cases of the deficiency, 80% of which involved children below twelve years. Research shows that one out of five men and one out of nine women suffer have been affected by vitamin D deficiency. This statistic is the highest the country has recorded in ten years since the county established and implemented strict measures to curb its spread in the population, especially among children. Health experts in America consider vitamin D deficiency as a historically significant disease. This project evaluates the prevalence of vitamin C deficiency in America, the affected population, and the measures in place to deal with the issue.

Introduction

Over time there have been debates at the national level regarding Vitamin D deficiency, whether or not to categorize it as chronic by the government through the healthcare department. Many healthcare practitioners have discovered a strong correlation between high vitamin D deficiency levels and the unhealthy lifestyles of older people in America. Recently Americans have embraced an unhealthy lifestyle that constitutes lousy eating habits, little attention to vitamins and vegetables in a diet, lack of exposure to enough sunlight, and most importantly, ignoring exercises and their significance in strengthening bones and improving one’s health. The most affected individuals in developed nations are children below ten years, particularly children from low-income backgrounds. It is the case because children are vulnerable and still growing, thus requiring attention and a good diet. Their bones are still weak and prone to illnesses if they lack enough vitamins in their foods. This paper will discuss the prevalence of vitamin D deficiency in America, its implications, and the appropriate measures to eliminate the issue in the country.

Background

Understanding vitamin D, its importance, and the causes of Vitamin D deficiency give a better understanding of its prevalence in developed countries like America. Vitamin D deficiency, also known as Hypovitaminosis D, means that an individual is not getting enough vitamin D nutrients in their body to sustain them and keep them healthy. The hormonally active vitamin D3 is a lipid-soluble compound known as 1,25-dihydroxy vitamin D3 (cholecalciferol). The lipid-soluble vitamin is significant because it affects bone metabolism and calcium homeostasis. Vitamin D is essential for the body because it helps it absorb calcium easily from food. It also plays a vital role in strengthening individuals’ muscle, nervous, and immune systems. Vitamin D can be acquired into the body in three significant ways. The most common form is through the skin, followed by diet, and finally through supplements. Absorption of vitamin D through the skin is common because it only requires exposure to sunlight daily. The human body is unique because it has mechanisms and the ability to form Vitamin D naturally after exposure to sunlight. The risk of developing damaged skin, aging skin, and cancer through excessive sunlight have seen many people in America acquire vitamin D and ultimately prevent vitamin D deficiency through other methods like dietary and supplements.

The need for vitamin D in the body to free an individual from the risk of vitamin D deficiency varies depending on age. People at high risk of Vitamin D deficiency need more vitamin D in their bloodstream. Since children are prone to vitamin D deficiency, they require approximately 600 IU. The same goes for young adults pregnant and breastfeeding mothers. Adults over 71 years old require more vitamin D because their bones are very fragile and require a constant dose of vitamin D. They need approximately 800 IU to get off the radar of vitamin D deficiency. Several groups of people in developed countries are at risk of getting vitamin D deficiency. Infants are the most vulnerable because they depend on breastmilk as their source of nutrients. According to Hassan-Smith and colleagues, breastmilk is a poor source of Vitamins prompting most parents to top it up with supplements. Individuals taking anti-seizure, anti-fungal, glucocorticoids, HIV/AIDS, and cholestyramine drugs are known to slow vitamin D mechanisms are also at high risk of getting vitamin D deficiency.

Data collected by the National Health and Nutrition Examination Survey (NHANES) between the years 2005-2008 established that out of 4495-individual sample size, 41.6% registered levels of vitamin D deficiency. The research also determined that race was a key factor in the deficiency for two fundamental reasons. One is because skin pigmentation reduces the absorption and synthesis of vitamin D. Vitamin D is a vital hormone synthesized by the skin and is responsible for pigmentation. The synthesis is highly dependent on melanin concentration on the skin. Generally, melanin is known to scatter and distribute the ultra-violet rays harvested from the sunlight, causing inefficient conversion of 7-dehydrocholesterol to pre-vitamin D3. Therefore, this aspect means that people with the darkest melanin experience slower vitamin D synthesis than light-skinned individuals. Studies have suggested a positive correlation between skin lightness and 25-hydroxyvitamin D (25(O.H.) D) levels. Research by Vitamin D External Quality Assessment Scheme Organization DEQAS states that fair-skinned children in developed countries recorded high pigmentation values meaning their levels of 25(O.H.) D component is high in their skin. It explains why African Americans and Hispanics struggle to get vitamin D into their bodies and counter the deficiency.

Current Research Efforts

Most cases of vitamin D recorded emerged from the African American community, particularly the adults. Followed closely by the Hispanic adults. Research shows that these two groups are prevalent to vitamin D deficiency because of the demographic and economic disadvantage they have as marginalized groups in America. It is quite challenging for African Americans and the Hispanic group to secure suitable employment because of their skin color and the stereotypical nature of society. For this reason, they struggle to offset their finances, tax payments, and their needs, including a healthy meal. The consumption of foods with vitamin D nutrients and supplements proves difficult for these groups because of the affordability factor. Consequently, calcium absorption in their bodies is limited hence developing vitamin D deficiency over time.

Vitamin D deficiency can result in bone density loss, a factor that contributes to fractures or broken bones and osteoporosis. In children, severe vitamin D deficiency can lead to rickets. Rickets is a rare disease that affects young children and comes about due to inadequate vitamin D, which makes it difficult for them to absorb calcium and phosphorus. Rickets causes the bones of children to soften and weaken hence bending the legs and making a bow shape. Rickets also causes pain in the pelvis, spine, and legs. Nutritional rickets has been reported from at least 59 developed countries in the past twenty years. A study revealed that in North America, rickets as a result of vitamin D deficiency is common among children with relatively pigmented skin because they are exclusively breastfed. In countries like Australia, vitamin D deficiency is prevalent in immigrant populations. Most of these immigrants originate from the Indian and Middle East countries. Studies further show that rickets and vitamin D deficiencies reported in developed continents like Europe are common among children whose mothers lack adequate calcium in their bodies or are sun-protected. This deficiency can manifest later in adulthood as bone problems. The manifestation of vitamin D deficiency in extreme cases like rickets occurs mainly in children’s second and third years.

A study facilitated by National Health and Nutrition Examination Survey (NHANES) in Europe shows that vitamin D deficiency burdens specific populations in the country. It contributes massively to the downstream clinical reverberations ranging from cancer, osteoporosis, heart diseases, diabetes, clinical features to fractures and kidney problems. The populations affected mainly by vitamin D deficiency find it challenging to access foods rich in vitamin D. Researchers have demonstrated that populations prone to vitamin D deficiency like the Latinos and black Americans get their vitamin D mainly from exposure to ultraviolet rays in sunlight. It provides the lipid-soluble compound of vitamin D3 and maintains the synthesis of nonenzymatic dermal in the body. According to the Vitamin D Standardization-Certification Program (VDSCP), sources of vitamin D2 such as fungal and dietary plants such as mushrooms that boost calcium absorption in the body are quite expensive in developed nations. Other alternative vitamin D3 sources like animal products, particularly fatty fish, are too costly for the marginalized groups in America to afford. These statistics explain why they are more prone to getting vitamin D deficiency.

Discussion

The changes in patterns and prevalence of vitamin D deficiency in developed countries have gained the interest of many medical researchers and practitioners. Anthropometric, demographic, and lifestyle factors predict vitamin D deficiency, rickets, and bone problems among adults worldwide. According to the Vitamin and Mineral Nutrition Information System (VMNIS), vitamin D status deteriorates over seventy years. The main factors contributing to the difficulty in acquiring and synthesizing vitamin D during old age are the little exposure to the ultra-UV rays from sunlight due to limited movements and cutaneous synthesis. Cutaneous synthesis of vitamin D in an individual’s body also depends on the clothes they choose to put on and sunscreens used to protect the skin from harmful U.V. rays from the sun. RESEARCH under controlled conditions revealed that sunscreens hinder the synthesis and absorption of vitamin D and the ultimate extraction of calcium and phosphorus from the vitamin D into the body. The Centers for Disease Control and Prevention and Nutrition International (N.I.) counter these arguments by suggesting that the regular use of sunscreens to protect the skin causes little to no damage because it does not impair the vitamin D production and synthesis process. The different points of view surrounding the screen raise a dilemma and debate on public health’s importance and effects of the product. Despite the solar radiations making up the primary vitamin D source, they are a risk factor for skin carcinogenesis and sunburns. Balancing the limit to skin damaged by sun radiations and generating adequate vitamin D to strengthen bones, muscle, and immune systems have created controversies among medical researchers worldwide.

The presence and amalgamation of vitamin D in the body also declines in patience with hip fractures. According to a 2019 report by the U.S. Department of Health and Human Services, 57.5% of elderly individuals with hip fractures in America have vitamin D deficiency, while 34.5% have vitamin D inefficiency. The health department adds that only 8% of people with hip fractures in America are free of vitamin D deficiency. A large percentage of vitamin D deficiency cases reported come from elderly female patients in America. The Comanaged Geriatric Fracture Centres record similar statistics as the low inpatient mortality regarding patients with hip fractures which stands at 1.95%. Studies have also suggested that cases of community-ambulant elderly patients with hip fractures are lower than state-bound cases. Housebound elderly patients are likely to get vitamin D deficiency because they do not expose themselves to enough sunlight. Lack of adequate sunlight means they don’t get ultra-violet rays from the sun, which is vital for synthesizing vitamin D and calcium absorption, responsible for strengthening bones.

Additionally, housebound elderly patients with hip fractures who have reduced physical activity are confined indoors for most of their lives. Lack of regular exercise makes their immune system weak, and they become vulnerable hence quickly succumbing to diseases that can cost their lives. Data collected by the National Health and Nutrition Examination Survey (NHANES) identifies other risk factors likely to increase the chances of inbound elderly patients with hip fractures getting vitamin D deficiency. These factors include coexisting illnesses such as renal and liver impairment and inadequate vitamin D dietary sources of vitamin D. Before admission to inbound states, statistics show that elderly patients with hip fractures residing in their homes and nursing homes did not have direct cases linked to vitamin D deficiency. However, a Turkish study conducted in 2019 revealed that patients living in nursing homes were at a higher risk of getting vitamin D deficiency compared to those living in their homes. It implies that the elderly living in their homes are well taken care of by their assistants or loved ones. They get balanced and enough meals every day, which boosts vitamin D levels in their bodies and eases conversion and absorption of vitamin D. Furthermore, they also get to go for regular walks that are not necessarily scheduled because of the personalized care. This aspect increases their exposure to sunlight and the acquisition of vitamin D through their skin.

Research by the United States Library of Medicine and National Institute of Health (2020) also found a strong correlation between the clothing habits of people in developed countries and higher risks of vitamin D deficiencies. Younger individuals with less pigmented skin tend to have balanced calcium, phosphate, and bone structure than fair-skinned adults or the elderly, thanks to their quick metabolism and vitamin D synthesis. Therefore, the elderly must increase their exposure time to sunlight twice as much or more to get the same level of vitamin D synthesis and protect themselves from vitamin D deficiency. Research in the United Kingdom and France has determined a relationship between latitude and the general vitamin D status in society. The Spanish Costa del Sol, which corresponds to a latitude of 37 degrees Celsius, recorded low vitamin D3 production in the residents’ bodies during winter. During winter, individuals put on heavy clothes covering most parts of their bodies. This aspect and little sunshine during this season contribute to lower levels of vitamin D deficiency in individuals living in developed nations.

Vitamin D deficiency prevalence also depends on the lifestyle of individuals in developed countries. Studies show that countries like Saudi Arabia, which is in the Middle East, recorded high cases of vitamin D deficiencies because of their clothing habits. Their culture dictates that they cover most parts of their bodies, especially in social settings. The study further revealed that women depicted more vitamin D deficiency signs than their male counterparts, thanks to their dressing habits. Countries with the lowest 25(O.H.) D levels recorded high vitamin D deficiency cases, especially in veiled women. Undoubtedly clothing limits their access and exposure to sunlight containing the U.V. rays responsible for the synthesis of Vitamin D. Other studies in Europe show that vitamin D deficiency is common among people living near the equator. Over the years, the prevalence of the deficiency has intensified around these areas. Researchers based in fourteen European countries applied Vitamin D Standardized Program (VDSP) protocol in their research and determined that 13.0% of the population displayed a low concentration of the serum 25-hydroxyvitamin D (25OHD. This statistic translates to approximately 55,844 people living around the equator. The results mean that the vitamin D concentration in the blood is below average, which is 30 nmol/l regardless of clothing habits, ethnic background, and age group.

Studies have established that 15-30 minutes exposure of hands and face to enough sunlight wavelength (UVB radiation of 290–370 nm) at around eleven to one P.M is enough to achieve a standard vitamin D concentration in the body. There are sufficient UVB radiations responsible for Vitamin D production in regions with a latitude of forty degrees south and 40 degrees north. Routine tests of vitamin D concentration (25OHD have not been conducted in sunny developed countries because of the assumption that vitamin D deficiency is not a severe issue. The health departments of developed sunny countries ignore vitamin D deficiency because they believe there is enough sunlight as a source of vitamin D. However, it should be noted that vitamin D deficiency might be higher in such countries due to ignorance. The sun might be the primary source of Vitamin D, but it is not the only source. There are other sources like dietary and supplements that need consideration. Researchers have suggested that UVB radiations are inadequate and sometimes not present during winter in countries outside the latitudes of forty degrees North and South. Therefore, people living in such reasons are forced to substitute their vitamin D source with supplementation and food. They rely on these sources to balance the serum vitamin D in their bodies as a measure against getting vitamin D deficiency. It is undeniable that geographical location plays a vital role in determining vitamin D deficiency. The ignorance of routine checks for Vitamin D deficiency in sunny areas raises questions and debates among different groups of people and heads worldwide and the course of action.

Vitamin D Deficiency and Osteomalacia

Osteomalacia is a bone disease that softens the bones and makes them weak in adults, eventually leading to the bowing of the weight-bearing bones of the legs during growth. This disease comes about due to the inadequacy of phosphorus or calcium that results in defective mineralization. Severe vitamin D deficiency causes Osteomalacia disease because it facilitates excessive calcium resorption from bone. This disease is closely associated with rickets in children since it has the same effect on the patients. Studies in Australia have determined that osteoporosis and falls and their subsequent fractures risks are the leading cause of vitamin D deficiency in the musculoskeletal health in adults living in industrialized countries. These conditions contribute massively to high healthcare costs and morbidity in developed countries. The National Health and Nutrition Examination Survey (NHANES) suggests that despite the prevalence of vitamin D deficiency in developed countries, osteoporosis and falls conditions are not suitable determinants of vitamin D status in the population. The institution adds that intervention to vitamin D deficiency in people of developed countries such as fortification and supplementation should not be based on these two conditions because they do not accurately represent vitamin status.

Vitamin D deficiency and Tuberculosis Asthma and Acute respiratory infections

Studies have revealed substantial evidence linking vitamin D deficiency with the development of respiratory difficulties, specifically the reactivation of tuberculosis and aggravation of asthmatic attacks. The inadequacy of Vitamin D in an individual’s body impacts the balance of their immune system adversely, weakening the body and making it vulnerable to illnesses like tuberculosis and asthma. A recent study stated that a consistent intake of vitamin D supplements increases one’s immunity and decreases the frequency of asthma and other Upper Respiratory Infections. The research also determined that Acute Respiratory Infections are common for children under the age of five in both developed and developing countries. Approximately 300 people worldwide are asthmatic. Out of this figure, 250 000 people succumb to death annually thanks to asthma, particularly acute asthma attacks. It is safe to conclude that enough vitamin D concentration in the body eases the disease burden on people residing in countries with high economies.

The supplementation trials conducted by Parva and colleagues revealed that vitamin D supplements were responsible for a significant decrease of severe asthma episodes requiring urgent medical attention and a decrease in the asthma aggravation frequencies requiring the corticosteroid treatment. Two trials facilitated by the authors involving maternal prenatal vitamin D supplementation showed a significant decline in the offspring recurrent incidences of asthmatic attacks. Additionally, research shows that vitamin D plays a vital role in preventing Mycobacterium tuberculosis infections in adults living in industrialized countries. Vitamin D concentration in the body is used as concomitant therapy to improve response to antimicrobial treatment and prevent active tuberculosis. Vitamin D deficiency, therefore, leaves the body vulnerable to life-threatening conditions and ultimate loss of life if not adequately addressed.

Recommendations

The high prevalence of vitamin D deficiency has prompted the governments of many industrialized countries to develop strategies and measures to tackle the adverse impacts of the deficiency on the population and the ultimate prevention against it. Efforts have been established to cover all vitamin D sources but focus primarily on food as a dietary source. Various foods programs are already in motion to tackle the issue and reduce the burden of vitamin D deficiency on the population. In addition, the government and stakeholders in programs put in place to handle vitamin D deficiency can use recommendations to come up with appropriate and practical solutions to achieve a vitamin D deficiency-free population

Developed countries need to evaluate vitamin D status in the population by measuring serum/plasma 25(O.H.) D. Public health intervention should be considered if more than 20% of the overall population records a low vitamin D concentration in the body. It should not fall below the standard vitamin D concentration in the body, 30 nmol/L. Once the vitamin D status has been established, the government, through its health department, can put measures in place to help the population evade vitamin deficiency. This action will help government agencies and relevant stakeholders to know the population affected by the deficiency, determine the resources required to facilitate their initiative, materialize it gradually and assure people of their health as far as vitamin D deficiency is concerned.

Furthermore, the government can include a mandatory or voluntary fortification in its national legislation. To materialize all the fortification initiatives, the government must identify the most fortifiable, widely consumed, and culturally acceptable vehicle. The most effective strategy to increase dietary intake of specific foods rich in vitamin D is fortifying government-mandated staple food in industrialized countries. The United States and Canada are already ahead with this initiative as they have mandated vitamin D through fortifying infant milk, evaporated milk, nonfat dry milk, and baby formula. This strategy will prevent children from developing rickets by providing enough calcium and phosphorus. The government should oversee the fortification of mandatory foods rich in vitamin D to ensure its safe levels and appropriate formulations in the respective foods.

The government should also devise a plan to use vitamin D supplements to ensure enough vitamin D consumption and decrease deficiencies and related illnesses. Sources of vitamin D supplements such as cod liver oil, which has the highest vitamin D content, should be maximized such that there is enough for all residents in developed nations. There is a need to employ new technologies and inventions to increase the production of supplements and control vitamin D deficiency. Stakeholders should also take the initiative and invest adequate resources in unraveling more forms of vitamin D such as capsules, drops, and tablets. Countries like the United States have already included various point-of-use multi nutrients fortification products such as lipid-based nutrients supplements, LNSs, and micro-nutrient power MNPs to counter vitamin Deficiency, especially among young children. The supplementation initiatives towards this course will improve vitamin D status, reducing vitamin D deficiency cases.

Advocacy

It is vital to create professional and public awareness regarding the risk factors and consequences of the deficiency to alleviate the disease burden that results from the prevalence of vitamin D deficiency in developed countries. There is a need for collaboration between local and international organizations to estimate the prevalence of vitamin D deficiency and strategize and implement effective and specific interventions to improve vitamin D status and acquisition in industrialized countries. Diverting attention to vitamin D deficiency, proper assessment, and monitoring the program’s effectiveness enable governments and stakeholders to determine if they are in the right direction and invest more in the most effective strategy.

Undoubtedly, vitamin D deficiency prevalence in developed countries is an issue that requires attention from different parties in the respective countries. Its evaluation should be based on recent statistics to represent the population accurately. This action will allow various programs that work hand in hand with the government to reduce the deficiency prevalence to channel resources towards the right course and achieve positive outcomes of vitamin D status. Incorporating vitamin D supplementation into childhood vaccination programs would be an effective strategy to implement and deal with the issue. Immunization campaigns and vitamin D supplements should be advocated simultaneously to create open-mindedness among parents. This action eliminates adherence challenges of frequent dosages of vitamin D among people, especially parents. Public members should also take it upon themselves and incorporate the habit of consuming foods rich in vitamin D and exposing themselves to the right amount of sunlight to get adequate vitamin D into their bodies.

Limited data on the prevalence of vitamin D deficiency in developed countries gives the government and relevant stakeholders the wrong impression. This is the case because factors that increase the risk of getting vitamin D deficiency are widespread across countries, making it challenging for the government to pinpoint and handle them separately to achieve effectiveness. Therefore, it is essential to conduct meaningful, in-depth research to generate accurate information about vitamin D concentration to determine its course.

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